1912677360 NPI number — GREAT RISING PHARMACY

Table of content: (NPI 1912677360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912677360 NPI number — GREAT RISING PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT RISING PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912677360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3806 AVENUE I STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSENBERG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77471-3951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-363-3708
Provider Business Mailing Address Fax Number:
832-201-7414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3806 AVENUE I STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSENBERG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77471-3951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-363-3708
Provider Business Practice Location Address Fax Number:
832-201-7414
Provider Enumeration Date:
09/16/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
DAMIEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-809-1600

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)